Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 105988 | MN |
NPI | 1235796723 |
---|---|
Provider Name | Sophia Grace Burch |
First Address | Minneapolis, MN 55455-4800 |
Second Address | Minneapolis, MN 55455-4800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2019 |
Last Update Date | 21/05/2019 |